| NPI | 1699763375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX E8697) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX E8697) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2008-06-17 |